Ethics

An understanding of the principles and practices of clinical bioethics is essential to hospice and palliative care curricula and practice. Principles of clinical bioethics are incorporated into many of the activities of a hospice and palliative medicine clinician including the roles of preventing and mediating conflict and distress over complex medical decision, managing withdrawal of advanced life-sustaining therapies, and addressing requests for hastened death.  Ethics principles and practices are incorporated broadly into the curricular didactics and experiential learning.

This fellowship trains participants in the following Hospice and Palliative Medicine Core Competencies:

  • Describes ethical and legal issues in palliative care and their clinical management
  • Discusses ethical principles and frameworks for addressing clinical issues
  • Describes federal, state, and local laws and practices that impact on palliative care practice
  • Consults clinical ethicist when necessary
  • Describes professional and institutional ethical policies relevant to palliative care practice
  • Initiates informed relationship-centered dialogues about care
  • Assesses patient/family wishes regarding the amount of information they wish to receive and the extent to which they want to participate in clinical decision-making
  • Determines, in collaboration with patient/family, the appropriate participants in discussions concerning a patient’s care
  • Assesses patient’s and family members’ decision-making capacity, and other strengths and limitations of understanding and communication
  • Enlists legal surrogates to speak on behalf of a patient when making decisions for a patient without decision-making capacity
  • Recognizes differences between relationship-centered dialogues in adult and pediatric palliative care based on physiology, vulnerabilities, and developmental stages
  • Uses appropriate communication skills to deal with requests for physician aid in dying and discuss palliative sedation
  • Demonstrates knowledge of ethics and law that should guide care of patients, including special considerations around these issues in pediatric, adult, and geriatric palliative care, including: Informed consent; confidentiality; decision-making capacity; decision-making for children, adolescents, and older patients with dementia; limits of surrogate decision making; truth telling; foregoing life-sustaining treatment; medical futility; use of artificial hydration and nutrition; physician-assisted suicide; euthanasia; principle of double effect; organ donation; research ethics; nurse-physician collaboration; indications for referring to an ethics consultant; and conflicts of interest.

Didactics
Ethics cases
Optimum use of life sustaining treatment
Substance misuse (two sessions)
Medical marijuana
Ethics cases
Communication series
Delirium
Young adult issues
Bridge to the pediatric bedside
Cultural differences in palliative care
Palliative sedation
Decoding code status discussions
Feeding problems in advanced dementia
Physician aid in dying
Journal Club

Experiential learning
MEC Friday sessions
MGH psychosocial rounds
DFCI case based teaching
Psychiatric supervision
Psycho-oncology rotation
Hospice GIP patients
Interprofessional training